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E' \ <br />I have read, understand and can perform the duties listed above. If you believe you may require <br />accommodation, please discuss this with the hiring supervisor. <br />Employee Name (please print) Employee signature Date <br />I have discussed the duties with and provided a copy of this duty statement to the employee named <br />above. <br />Supervisor Name (please print) <br />Supervisor signature <br />Date <br />